Effect of Ischemia Duration and Door-to-Balloon Time on Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction: An Analysis From HORIZONS-AMI Trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction)

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• 作者：Abhiram Prasad ; MD^&lowast ; ; ^&dagger ; ; Bernard J. Gersh ; MB ; ChB ; DPhil^&lowast ; ; Roxana Mehran ; MD^&Dagger ; ; ^§ ; ; ^{roxana.mehran@mssm.edu" class="auth_mail" title="E-mail the corresponding author} ; Bruce R. Brodie ; MD^‖ ; Sorin J. Brener ; MD^§ ; ; ^¶ ; ; José ; M. Dizon ; MD^# ; Alexandra J. Lansky ; MD^&lowast ; &lowast ; ; Bernhard Witzenbichler ; MD^&dagger ; &dagger ; ; Ran Kornowski ; MD^&Dagger ; &Dagger ; ; Giulio Guagliumi ; MD^§ ; § ; ; Dariusz Dudek ; MD ; PhD^‖‖ ; Gregg W. Stone ; MD^§ ; ; ^#
• 关键词：ischemia duration ; myocardial infarction ; PCI ; perfusion ; STEMI
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2015
• 出版时间：28 December 2015
• 年：2015
• 卷：8
• 期：15
• 页码：1966-1974
• 全文大小：540 K

文摘

This study sought to investigate the effect of treatment delay on microvascular reperfusion in ST-segment elevation myocardial infarction (STEMI) patients from the large, multicenter, prospective HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial.

Background

Despite restoration of epicardial blood flow during primary percutaneous coronary intervention (PCI), one-third of patients do not obtain myocardial perfusion due to impairment in the microvascular circulation.

Methods

We examined the effect of symptom onset-to-balloon time (SBT) and door-to-balloon time (DBT) on myocardial reperfusion during primary PCI in STEMI, utilizing resolution of ST-segment elevation (STR) and the myocardial blush grade (MBG). The primary analysis was the relationships between SBT ≤2, >2 to 4, and >4 h and DBT ≤1, >1 to 1.5, >1.5 to 2, and >2 h with MBG and STR. Clinical risk was assessed using a modified version of the Thrombolysis In Myocardial Infarction risk score for STEMI.

Results

In 2,056 patients, absent microvascular perfusion (MBG 0/1) and STR (STR <30%) after primary PCI was significantly more common in patients with longer SBT, in patients with both low and high clinical risk profiles. By multivariable analysis, SBT (p < 0.0001), anterior infarction (p < 0.0001), reference vessel diameter (p = 0.005), lesion minimum lumen diameter (p < 0.0001), hyperlipidemia (p = 0.03), and current smoking (p = 0.001) were independent predictors of MBG 0/1, whereas SBT (p = 0.007), anterior infarction (p < 0.0001), and history of renal insufficiency (p = 0.0002) were independent predictors of absent STR. DBT (p < 0.0001) was an independent predictor of MBG 0/1. MBG 0/1 and STR<30% identified patients with increased 3-year mortality.

Conclusions

The present study suggests that delay in mechanical reperfusion therapy during STEMI is associated with greater injury to the microcirculation.